Abstract
The prognostic significance of multiple draining basins is controversial in melanoma because analyses have not adequately controlled for standard prognostic variables. We hypothesized that an analysis based on prognostically matched pairs of patients with multiple versus single drainage basins would clarify any independent role of basin number. We identified patients in our 40-year prospective database, who underwent preoperative lymphoscintigraphy, intraoperative sentinel node biopsy and wide local excision for cutaneous melanoma. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were compared in patients with multiple versus single drainage basins after matching by age, sex, Breslow depth, primary site, and stage at diagnosis. We identified 274 patients with multibasin drainage and 1,413 patients with single draining lymph node basins. Matching yielded 259 pairs (226 trunk, 27 head/neck, 6 extremity). Among matched pairs, multibasin drainage did not affect rates of lymph node metastasis (p = 0.84), OS (p = 0.23), DSS (p = 0.53), overall recurrence (p = 0.65), locoregional recurrence (p = 0.58), or distant recurrence (p = 1.0). Multivariable analysis linked higher T stage, ulceration, older age, and lymph node positivity to decreased DSS (p < 0.01) and DFS (p < 0.001). Number of drainage basins was not significant on univariable or multivariable analysis. This analysis, the first to match for standard prognostic factors, suggests that multiplebasin drainage as identified by lymphoscintigraphy has no independent biological or prognostic significance in primary cutaneous melanoma.
Highlights
Since the advent of lymphoscintigraphy for cutaneous melanoma it has become clear that some primary lesions will drain to more than one lymph node basin [1, 2]
In an effort to add to the current literature regarding the prognostic significance of multibasin drainage (MBD) found with lymphatic mapping of cutaneous melanoma, we have reviewed our experience with this clinical scenario in the modern era
Other reports have shown that number of drainage basins from primary cutaneous melanoma does not affect survival [3, 4], Figure 1 | (A) Ten-year overall survival for matched patients who had single basin drainage (SBD) and multibasin drainage (MBD)
Summary
Since the advent of lymphoscintigraphy for cutaneous melanoma it has become clear that some primary lesions will drain to more than one lymph node basin [1, 2]. In the multi-institutional randomized Sunbelt Melanoma trial [3], 351 patients with MBD did not have worse outcomes; their rate of locoregional recurrence was lower than that of the 1,709 patients with single draining lymph node basins. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were compared in patients with multiple versus single drainage basins after matching by age, sex, Breslow depth, primary site, and stage at diagnosis. Results: We identified 274 patients with multibasin drainage and 1,413 patients with single draining lymph node basins. Multibasin drainage did not affect rates of lymph node metastasis (p = 0.84), OS (p = 0.23), DSS (p = 0.53), overall recurrence (p = 0.65), locoregional recurrence (p = 0.58), or distant recurrence (p = 1.0). Number of drainage basins was not significant on univariable or multivariable analysis
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